Chapter 19: Addiction

Clonidine is most effective for which symptom of opioid withdrawal?

Diarrhea Explanation: Clonidine is most effective against nausea, vomiting, and diarrhea but produces modest relief from muscle aches, anxiety, and restlessness.

A client with chronic alcoholism has been found to have Wernicke encephalopathy. This irreversible complication is characterized by what?

Thiamine, or vitamin B1, deficiency Explanation: Wernicke encephalopathy is associated with a deficiency in thiamine, or vitamin B1.

High doses of alcohol produce which effect?

Vomiting Explanation: An overdose, or excessive alcohol intake in a short period, can result in vomiting, unconsciousness, and respiratory depression.

A client with a long history of alcohol abuse is hospitalized. The client's last drink was at noon. The nurse would anticipate symptoms of withdrawal beginning no later than what time?

midnight Explanation: In patients with alcoholism and in chronic drinkers, the alcohol withdrawal syndrome usually begins 4 to 12 hours after abrupt discontinuation or attempt to decrease consumption. Since the last drink was at noon, withdrawal symptoms could appear as early as 4:00 p.m. but would almost certainly begin no later than midnight.

Which statement about clients with a dual diagnosis is accurate?

Traditional methods of treatment have not been very successful for these clients. Explanation: Traditional methods of treatment for major psychiatric disorders and substance dependency (i.e., substance dependency programs) have not been successful in treating clients with dual diagnoses.

According to the psychodynamic theory regarding addiction, it is most important that the nurse assesses the client with an alcohol use disorder by considering what?

Asking the client to describe the client's childhood relationship with the client's parents Explanation: According to the psychodynamic theory regarding addiction, it is most important that the nurse assesses the alcoholic client by asking the client to describe the client's childhood relationship with the client's parents. Children of people with alcohol use disorders are four times more likely to develop alcoholism compared with the general population.

A client is admitted to the emergency department after using MDMA (Ecstasy). The nurse identifies this drug as belonging to what class?

Hallucinogen Explanation: MDMA (3-4 methylenedioxymethamphetamine), or Ecstasy or Molly, is a hallucinogen and is known as a "designer drug" because it is used by teens and young adults as part of the nightclub, bar, and rave scenes. MDMA, similar in structure to methamphetamine, causes serotonin to be released from neurons in greater amounts than normal. Once released, this serotonin can excessively activate serotonin receptors.

Suspicion that a nursing professional is impaired by a substance abuse problem is most supported by which situation?

Having several clients complain that their pain medication is not working Explanation: Suspicion that a nursing professional is impaired by a substance abuse problem is most supported by having several clients complain that their pain medication is not working. An additional risk factor for health care providers and chemical dependency is access to and availability of drugs, training in the administration and injection of drugs, and a familiarity with and a frequency of administering drugs. A nurse who is chemically dependent may divert clients' pain medication to self-administer it; the clients then believe that their medication is not working when in fact they did not receive it. The other situations listed may also indicate a substance abuse problem, but there may be other explanations, whereas a pattern of client complaints that pain medication is not working is strong evidence for a substance abuse problem among the staff.

When discussing methadone treatment with a client, the nurse should include what?

It decreases the severity of heroin withdrawal symptoms. Explanation: Methadone is a substitute for heroin, reducing the severity of heroin withdrawal symptoms. It does not cure heroin addiction, and it is an addictive drug.

Which statements identify positive aspects of methadone as a substitute for heroin? Select all that apply.

It is a legal medication. It is controlled by a health care provider. It is available in tablet form. Explanation: Methadone is safer than heroin because it is legal, controlled by a health care provider, and available in tablet form. It also does not produce the high of heroin, and withdrawal has fewer symptoms. Methadone is a synthetic opiate; this allows it to be substituted for heroin.

The psychiatric nurse managing the care of a client experiencing alcohol withdrawal instructs unit staff to anticipate that the client may experience which neurological response?

Tactile hallucinations Explanation: Alcohol withdrawal can be the origin of tactile hallucinations. Alcohol withdrawal is not usually the origin of gustatory hallucinations or delusions of any type.

A client is prescribed disulfiram as part of the alcohol treatment program to prevent relapse. The client asks the nurse, "How will this drug help me?" Which response by a nurse would be most appropriate?

"It can help to prevent you from drinking." Explanation: Disulfiram is not a treatment or cure for alcoholism, but it can be used as adjunct therapy to help deter some individuals from drinking while using other treatment modalities to teach new skills on coping with altering abuse behaviors. Disulfiram plus even small amounts of alcohol produces adverse effects. Disulfiram does not affect withdrawal symptoms and does not eliminate alcohol from the body.

A client has entered treatment for alcohol dependency at the client's spouse's insistence. The client's spouse has threatened to leave the marriage unless the client seeks treatment. The client admits that the client drinks every day, but that the drinking is well in control. The nurse recognizes the client's comments as denial. What is the best response by the nurse?

"What negative consequences have resulted from your drinking?" Explanation: To confront denial, the nurse points to the evidence of severe dysfunction that inevitably appears in the substance abuser's life. Job losses, financial problems, possible estrangement from family and friends, and legal problems are common, and the nurse can respectfully but firmly remind the client that many of these problems are a result of alcohol or drug abuse.

The nurse is providing support to a client's child regarding the parent's alcohol use disorder. When integrating the disease concept treatment approach about this type of disorder, which statement by the nurse would be most effective?

"Your parent's alcohol use problem is a chronic disease but can be treated." Explanation: According to the Disease Concept, alcoholism is considered a chronic disease with modalities in place to help manage it. Thus, the most assuring response by the nurse is, "Your parent's alcohol use disorder is a chronic disease that can be treated." The other statements do not address this concept.

In a person who abuses alcohol or is a chronic drinker, alcohol withdrawal syndrome usually begins within which time frame from abrupt discontinuation or an attempt to decrease consumption?

12 hours Explanation: In clients with alcoholism or in chronic drinkers, alcohol withdrawal syndrome usually begins within 12 hours after abrupt discontinuation or an attempt to decrease consumption.

A client is in treatment for depression and alcohol abuse. The client is unwilling to confront substance abuse issues, stating the client uses alcohol to ease feelings of depression. The client's spouse reports that the spouse often has to care for the client when the client is hung over, calling in sick for the client and doing what the spouse can to help the client catch up with household or job responsibilities. The nurse diagnoses the client's family with dysfunctional family processes. The nurse and clients develop a plan of care. Which goal indicates an understanding of the family situation and the linkages between the diagnosis and the outcomes?

The spouse will refrain from the enabling the client's drinking behaviors. Explanation: Codependency needs attention from staff and counselors to learn to adjust to the sober spouse and to develop a less vigilant, more interdependent relationship. The nurse recommends that family members begin their own recovery by attending support groups such as Al-Anon or Alateen.

The mental health nurse recognizes that genetic intolerance of alcohol has been documented among which ethnic group?

Asians Explanation: Asians have a genetic intolerance to alcohol even when consumed in small amounts. Such an intolerance has not been identified in those of African, Italian, or German descent.

Safe alcohol withdrawal usually is accomplished with the administration of which medication classification?

Benzodiazepines Explanation: Benzodiazepines are used for safe withdrawal of alcohol.

The mental health nurse should focus on preventative efforts including educational interventions related to the abuse of prescription drugs on which client group?

Both genders between the age of 12 and 17 Explanation: Prescription drug abuse among youth 12 to 17 years of age has been increasing at an alarming rate, so the mental health nurse concentrates assessments and educational interventions related to the abuse of prescription drugs on both genders between the age of 12 and 17.

While conducting an admission interview with a client, the nurse suspects the client may be in alcohol withdrawal. Which screening tool can help the nurse identify the severity of withdrawal symptoms?

CIWA-Ar Explanation: Once alcohol withdrawal is suspected, a screening tool such as the CIWA-Ar can assist nurses to identify the severity of symptoms.

A client is brought to the emergency department by a friend who tells the staff that the friend thinks the client has overdosed on cocaine. Which findings would help support this situation? Select all that apply.

Chest pain Seizures Tachycardia Cardiac dysrhythmia Explanation: Signs of overdose include cardiac dysrhythmias or arrest, increased or lowered blood pressure, chest pain, vomiting, seizures, psychosis, confusion, dyskinesias, dystonias, and coma. Nystagmus is a sign of inhalant overdose.

A client admitted for acute alcohol intoxication begins to experience mild sweating, tachycardia, fever, and nausea and vomiting. Of the following, the drug treatment of choice would be what?

Chlordiazepoxide Explanation: Chlordiazepoxide would be the drug of choice to manage alcohol withdrawal.

A client enters the emergency room exhibiting tremors, agitation, and restlessness. Upon assessment, the client's blood pressure is 160/90, pulse is 110, and respirations are 22. It has been 36 hours since the client's last drink of alcohol. The nurse would suspect which conditions to be occurring?

Delirium tremens Explanation: Delirium tremens may occur 24 to 72 hours after the client's last drink. Elevation of vital signs accompanies restlessness, tremulousness, agitation, and hyperalertness. Tolerance is a need for markedly increased amounts of alcohol to achieve the desired effect. Korsakoff's psychosis is a form of amnesia characterized by a loss of short-term memory and the inability to learn new skills. Wernicke's encephalopathy is an inflammatory hemorrhagic, degenerative condition of the brain caused by a thiamine deficiency.

A nurse suspects that a client is experiencing alcohol withdrawal based on assessment of which of the following?

Elevated temperature Explanation: A client experiencing alcohol withdrawal may exhibit tremors; seizures; increased temperature, pulse and blood pressure; and delirium tremors. Slurred speech would be seen as an effect of alcohol.

A client has a history of consuming alcohol almost daily while pregnant. Her newborn baby has growth deficiency and facial malformations. What is the name for the pattern of birth defects that can occur due to exposure to alcohol?

Fetal alcohol syndrome Explanation: Alcohol is a teratogen, meaning that it crosses the placenta when women drink during pregnancy and can cause adverse fetal effects. The most clearly alcohol-related birth defect is a specific pattern called fetal alcohol syndrome (FAS), the leading known preventable cause of intellectual disability. Manifestations of FAS include prenatal and postnatal growth deficiency; facial malformations, including a small head circumference, flattened midface, sunken nasal bridge, and flattened and elongated groove between nose and upper lip; central nervous system dysfunction; and varying degrees of major organ system malfunction.

The nurse in an outpatient rehabilitation program is speaking with a group of clients who have recently recovered from alcohol abuse. Which issue should the nurse raise before the clients leave for the day?

Help them to identify appropriate diversional activities. Explanation: Clients in recovery typically have devoted much time to their addiction. Substance use is integral to their existence and occupies most of their leisure time. In some cases, it also takes up work and family time. During treatment, clients may find themselves lonely, bored, idle, or conflicted about what to do with so much "free" time. They need to plan activities to minimize the temptation to revert to alcohol or drug use.

When a client is working toward the prevention of an alcohol abuse relapse, the nurse is acting in a therapeutic role when doing what?

Helping the client identify positive coping mechanisms Explanation: When a client is working toward the prevention of an alcohol abuse relapse, the nurse is most therapeutic when helping the client identify positive coping mechanisms.

A 47-year-old client has been admitted to the hospital after being found unconscious in a park. Upon regaining consciousness, the client admits to heavy alcohol use over many years. Assessment reveals a low body mass index, low electrolyte levels, and impaired skin integrity. Vital signs are within normal ranges. What nursing diagnosis should be prioritized in the care of this client?

Imbalanced nutrition: less than body requirements related to chronic alcohol intake Explanation: High alcohol intake is associated with malnutrition, which can result in low electrolyte levels, low body mass index, and impaired skin integrity. This diagnosis is of more immediate concern than the client's coping, knowledge, or future risk for injury.

A group of nursing students is reviewing information about nutritional supplementation used during alcohol detoxification. The students demonstrate the need for additional review when they identify which of the following as being used?

Naloxone Explanation: Naloxone (Narcan), an opioid antagonist, is given to reverse the respiratory depression, sedation, and hypertension for opioid intoxication. Multivitamins and adequate nutrition are essential for clients who are withdrawing from alcohol. Because malnutrition is common, other vitamin replacement may be necessary for certain individuals. Thiamine (vitamin B1) is initiated during detoxification, given to decrease ataxia and other symptoms of deficiency. It is usually given orally, 100 mg four times daily, but can be given intramuscularly or by intravenous infusion with glucose. Folic acid deficiency is corrected with administration of 1.0 mg orally four times daily. Magnesium deficiency also is found in those with long-term alcohol dependence. Magnesium sulfate, which enhances the body's response to thiamine and reduces seizures, is given prophylactically for clients with histories of withdrawal seizures.

Safety is the nursing priority for a client who is at risk for alcohol withdrawal. A care plan for the client who is in withdrawal must include which nursing interventions?

Observation for symptoms, vital signs, seizure and fall precautions, medications as ordered Explanation: Nursing care of the client experiencing withdrawal centers on safety first. The nurse must implement frequent vital sign assessment, seizure precautions, and fall precautions to ensure the client's safety. Withdrawal symptoms must be controlled with medications.

A nurse observes a colleague who has unsteady gait and slurred speech. The nurse suspects that the colleague, a nurse, is impaired. Which would be the appropriate action to take?

Report the colleague's behavior to the supervisor Explanation: Nurses need to report suspicions about colleagues to ensure client safety. Increasingly, state boards of nursing require nurses to report colleagues whom they suspect have substance use disorders. The first report should be to the impaired nurse's immediate supervisor, with as many documented facts as possible.

A 52-year-old client has a history of alcohol dependence and is admitted to a detoxification unit. The client has tremors, is anxious, has a pulse that has risen from 98 to 110 beats/min, has blood pressure that has risen from 140/88 to 152/100 mm Hg, and has a temperature 0.6º above normal. The client is slightly diaphoretic. Which nursing diagnosis would be the priority?

Risk for injury Explanation: The client is experiencing alcohol withdrawal, and protecting the client from injury is the priority at this time. Although the client may be coping ineffectively or denying the alcoholism, the client's physical safety is a top priority. There is no indication to suggest that the client's thought processes are disturbed.

A client who is abusing substances is to undergo brief intervention. The nurse understands that this technique is most effective for a client who exhibits which symptoms?

Short history of drug use Explanation: Brief intervention is most successful when working with individuals who are experiencing few problems with their drug use, have low levels of dependence, have a short history of drug use, and have stable backgrounds.

A nurse who started recovering from alcohol abuse 3 months earlier is ready to return to work. When speaking with the therapist, the nurse states the nurse is nervous about how coworkers will respond to the nurse now that "they all know I'm a drunk." Which diagnosis best targets the problem implicit in the nurse's remarks?

Situational low self-esteem related to medical condition Explanation: Each client enters recovery with a different personality and psychosocial history. In most cases, however, the client's self-esteem may be low because he or she can no longer hide from the devastation caused by substance abuse and related behaviors. Guilt, shame, embarrassment, and despair are common feelings in the early stages of recovery.

A nursing student is aware that which accounts for more deaths, illnesses, and disabilities across the life span than any other preventable condition?

Substance abuse disorders Explanation: Substance abuse disorders across the life span account for more deaths, illnesses, and disabilities than any other preventable health condition.

Which factor would contraindicate the use of disulfiram in the treatment of a client who has an alcohol use disorder?

The client had six drinks a few hours ago. Explanation: Disulfiram may not be administered to a client who is acutely intoxicated. A family history of alcoholism, marijuana use, and binge drinking do not preclude the use of the drug.

The client was diagnosed with cocaine abuse at age 30. When the client was 23, the client was diagnosed with major depressive episode, and has continued to have depression off and on since then. Which statement would reflect this situation?

The client most likely has a dual diagnosis since she has both a substance dependence and depression. Explanation: The client has a dual diagnosis: a primary substance dependence and a mental health disorder. The client requires concurrent treatment of both disorders. Cocaine is a stimulant so it would counteract the action of the antidepressants. Prognosis is variable and dependent on the effectiveness of the treatment for both disorders.

A client with opioid addiction is prescribed methadone maintenance therapy. When explaining this treatment to the client, which of the following would the nurse need to keep in mind?

The drug helps to satisfy the craving for the opioid. Explanation: Methadone maintenance is the treatment of people with opioid addiction with a daily, stabilized dose of methadone. Methadone is used because of its long half-life of 15 to 30 hours. Methadone is a potent opioid and is physiologically addicting, but it satisfies the opioid craving without producing the subjective high of heroin.

The mental health nurse is preparing a presentation about prescription drug abuse to a local community group. When describing the incidence, which age group would the nurse identify as experiencing an increase?

Adolescents Explanation: Alcohol, tobacco, marijuana, and illegal prescription drug use have reached epidemic proportions in the United States, with the incidence rising in younger age groups, particularly among adolescents and young adults.

Ecstasy is an example of which type of substance?

Hallucinogen Explanation: Ecstasy is an example of a hallucinogen.

A nurse is caring for a client who uses phencyclidine (PCP). PCP is classified as which type of substance?

Hallucinogen Explanation: PCP is classified as a hallucinogen. Heroin and morphine are considered opioids. Examples of inhalants are aerosols and adhesives. Cannabis is also known as marijuana.

Which medication is used to prevent alcohol withdrawal symptoms?

Lorazepam (Ativan) Explanation: Safe withdrawal usually is accomplished with the administration of benzodiazepines, such as lorazepam, chlordiazepoxide, or diazepam, to suppress the withdrawal symptoms.

When interviewing the family members of a client being treated for substance abuse problems, which of the following behaviors by the members would alert the nurse to the possibility of codependency?

Making excuses for the client's substance problem Explanation: Codependence has also been described as "enabling," in which an individual in a relationship with a person who abuses alcohol inadvertently reinforces the drinking behavior of the abuser. Making excuses for the client's substance abuse problem suggests codependency. Being flexible but angry and expressing thoughts and feelings openly indicates identification of the problem. Taking pleasure demonstrates positive coping, not enabling behavior.

A client is admitted to the detoxification unit on Sunday evening. The client discloses that the client's last alcoholic drink was just before the client was admitted to the unit. When can the nurse expect that the client's alcohol withdrawal symptoms will begin?

Monday morning Explanation: Symptoms of withdrawal usually begin within 12 hours after cessation or marked reduction of alcohol intake.

Which term describes a situation that occurs when very small amounts of alcohol intoxicates the person after continued heavy drinking?

Tolerance break Explanation: After continued heavy drinking, the person experiences a tolerance break, which means that very small amounts of alcohol intoxicate the person. A blackout is an episode during which the person continues to function but has no conscious awareness of his or her behavior at the time or any later memory of the behavior. Tolerance occurs when the person needs more alcohol to produce the same effect. Intoxication is use of a substance that results in maladaptive behavior.

A nurse is conducting a class for a group of high school students about marijuana use and abuse. The nurse determines that the class needs further discussion when they state which of the following?

Users of marijuana always experience relaxation and euphoria. Explanation: While pleasurable for most people on most occasions, marijuana use can induce feelings of anxiety and dysphoria. Other potential negative effects include delirium or a psychotic disorder. Ingestion of marijuana disrupts coordination of movement, balance, and reaction time. It can also result in hypotension and tachycardia. Some cannabinoids have been approved for some medical uses, such as treatment of nausea and vomiting resulting from chemotherapy, and research into additional medical uses is ongoing.

An appropriate goal for a client newly admitted to the unit for alcohol withdrawal is what?

Verbalize feeling safe and comfortable. Explanation: The client should verbalize feeling safe and comfortable. The other answer choices are goals for longer-term treatment—i.e., after the detoxification process has been successfully completed.

A client is admitted to the emergency department for intoxication with alcohol. The client has an unsteady gait, myopathy, and neuropathy and cannot remember past or recent events. When treated with thiamine, the client's symptoms greatly improve. Which condition was the client likely experiencing?

Wernicke-Korsakoff syndrome Explanation: Wernicke-Korsakoff syndrome is the coexistence of Wernicke's encephalopathy and Korsakoff's psychosis. Wernicke's encephalopathy is characterized by ataxia, nystagmus, ophthalmoplegia, and mental status changes. Korsakoff's psychosis involves gait disturbances, short-term memory loss, disorientation, delirium, confabulation, and neuropathy.